1. science
2. social science
3. philosophy
4. ethics

BC Cancer Agency Research Ethics Board - Behavioural – SAMPLE FORM
1. PRINCIPAL INVESTIGATOR & STUDY TEAM - HUMAN ETHICS APPLICATION
* 1.1. Principal Investigator
GUIDANCE NOTES
Please select the Principal Investigator (PI) for the study. Once you hit
A Principal Investigator (PI) either has a faculty
"Select", you can enter the PI's name, or enter the first few letters of his or appointment (Clinical Assistant Professor,
her name and hit "Go". You can sort the returned list alphabetically by
Clinical Associate Professor, Clinical Professor,
First name, Last name, or Organization by clicking the appropriate heading. Assistant Professor, Associate Professor,
Professor or BCCA Investigator) OR is deemed a
PI by an affiliated institution or by a Dean.
The PI bears the overall responsibility for the
conduct of the study and is required to act
within the guidelines of the TCPS2.
Enter Principal Investigator Primary Department and also the primary
location of the PI's Institution:
Instructors who are applying for research ethics
approval for class-based projects in courses they
are teaching can be listed as a PI on their
application. Please contact the REB manager if
you are submitting a class project and require
the capacity to list yourself as a PI on the
application.
If you cannot find the PI's name in the list, have
it added into the RISe system by emailing the
following information to RISe Support: Full
Name (Including Middle Initial), Department (or
affiliation with the University), UBC Rank, Email
Address, Phone Number and UBC employee
number (if applicable). Once an account is
created, new users will receive their researcher
number via email.
1.2. Primary Contact
Selecting a primary contact is optional. If a
primary contact is not selected, the PI will be the
only person to receive all correspondence from
the Research Ethics Board Administration
(REBA). Graduate students preparing ethics
Provide the name of ONE primary contact person in addition to the PI who
applications for their dissertation projects should
will receive ALL correspondence, certificates of approval and notifications
list themselves as the primary contact. The
from the REB for this study. This primary contact will have online access to
Primary Contact may also be listed in one of the
read, amend, and track the application.
categories below. Note that the PI may change
the Primary Contact anytime without an
amendment.
Study Team Members
Complete sections 1.3, 1.4 and 1.5 below to add Co-Investigators
and additional study team members and to designate the type of
online access you would like them to have.
Please make sure you have added yourself as
either the Principal Investigator, primary
contact, co-investigator, or a study team
member with online access in order to continue
with the application.
If you cannot find your name or any of your
study team members’ names in the list, have
them added or inform them to add themselves
by emailing the following information to RISe
1. Click "Add".
2. Enter the name, or enter the first few letters of the person's name and Support(risesupport@ors.ubc.ca): Full Name
(Including Middle Initial), Department (or
click "Go".
3. You can sort the returned list alphabetically by First name, Last name, or affiliation with the University), UBC Rank, Email
Address, Phone Number and UBC employee
Organization by clicking the appropriate heading.
number (if applicable). Once an account is
4. Select the boxes beside ALL applicable names and click "OK".
created, new users will receive their researcher
numbers via email.
To delete a person from the list, select the box next to his or her name
To add Co-Investigators and additional study team members in questions
1.3 and 1.4:
and click "Remove".
1.3. Co-Investigators
List all the Co-Investigators of the study. These members WILL have
online access which will allow them to read, amend and track the
application. These members will be listed on the certificate of approval
(except BC Cancer Agency Research Ethics Board certificates). If this
research application is for a graduate degree, enter the graduate student's
name in this section.
Last Name
First Name
Institution/Department
Rank
1.4. Additional Study Team Members - Online Access
List the additional study team members who WILL have online access to
read, amend, and track the application but WILL NOT be listed on the
certificate of approval.
Last Name
First Name
Institution/Department
Rank
1.5. Additional Study Team Members - No Online Access
Click "Add" to list study team members who WILL NOT have online access
to the application and will NOT be listed on the certificate of approval.
Last Name First Name Institution/Department Rank/Job Title Email Address
1.6. Tri Council Policy Statement (TCPS) Tutorial
* Tri Council Policy Statement2 (TCPS2) Tutorial
All undergraduate and graduate students and medical residents are
required to complete the TCPS2 Tutorial (CORE) before submission. This
tutorial provides an essential orientation to Canadian human research
ethics guidelines. The Principal Investigator and all Co-Investigators must
be familiar with the TCPS2. Indicate completion of the TCPS2 (CORE)
tutorial below:
1.6.A. All Undergraduate/Graduate Students:
* 1.6.B. All Medical Residents:
If you are applying to the BC Cancer Agency
(BCCA), co-investigators will not be listed on the
certificates of approval; however, all
participating BCCA centre PIs will be listed. You
will be asked to enter the BCCA centre PI's
names in View 11. For further information click
here for the BCCA Research Ethics Board
policy.
Examples of additional study team members
who you may wish to have online access to the
application include Clinical Trial Coordinators and
Research Assistants.
The study team members listed in this
section do not have online access to RISe.
Please print off the application and ensure that
each member listed in this section has read and
understood the objectives and procedures of this
study.
All non-Faculty personnel who are associated
with a research project and who will have
contact with the research participants are
required to complete the TCPS2 online tutorial
(CORE) before the application is submitted to
the REB. This includes (but is not limited to)
undergraduate and graduate students, medical
residents, research assistants, research
coordinators, etc. The REB requires that all
Principal Investigators be familiar with the
TCPS2 and recommends that Principal
Investigators also complete the TCPS2 tutorial,
especially when the Principal Investigator
supervises or teaches classes for graduate
students or medical residents.
The TCPS CORE Tutorial is free and can be
completed in about two hours. CORE Certificates
do not need to be attached. Copies should be
Comments:
retained by the PI and be available on request.
Click here for the TCPS2 Document.
* 1.7. Project Title
Enter the title of this research study as it will appear on the certificate. If
applicable, include the protocol number in brackets at the end of the
title. If this is a class-based project, see guidance on the right.
Click here for the TCPS2 'CORE' Tutorial.
The title given in the application form must
correspond to the title on all study documents,
including the consent form. If the study is
supported by research grant or contract funding
that is being administered by the University or
one of the teaching hospitals, the title should
correspond to the title on the grant or contract.
For studies that have multiple titles that
correspond with multiple funding sources, please
enter these titles and the respective funding
sources in question 2.4.
* 1.8. Project Nickname
Enter a nickname for this study. What would you like this study to be
known as to the Principal Investigator and study team?
For class-based projects please ensure to include
“Class Project” in the first part of the title and
the project nickname (question 1.8).
The nickname will not be printed on the
certificate. It will be used throughout the online
application and review process to serve as a
quick reference to identify the project.
For class-based projects, include “Class Project”
in the first part of the nickname.
For Family Practice Residency projects, include
“Family Practice Project” in the first part of the
nickname.
For Harmonized Review projects include
"Harmonized Review Project" in the first part of
the nickname.
2. STUDY DATES & FUNDING INFORMATION - HUMAN ETHICS APPLICATION
Project Period
In multi-phase projects, include the period that
involves research with human participants.
* 2.1.A.
Please choose ONE of the following:

You plan to start collecting data immediately after obtaining ethics
and any other required approvals (the start date on the ethics
certificate will reflect the approval date),

You plan to start data collection at a later date i.e., 2 months or
more after approvals are obtained. Click the calendar icon below to
select the dates (Internet Explorer) or enter the dates manually
using the format yyyy-mm-dd.
OR
Estimated start date:
* 2.1. B.
Estimated end date:
Source of Funds
"Source of Funds" refers to the funder, sponsor,
grantor, or agency (government, industry, and
non-profit) that is providing the funds needed to
* 2.2.A. Types of Funds
undertake the project. Note that you should not
indicate that your study is "For Profit" if a
Please select the applicable box(es) below to indicate the type(s) of funding
sponsor is only collaborating and not funding the
you are receiving to conduct this research. You must then complete
study, e.g., they are providing the study drug or
section 2.3 and/or section 2.4 for the name of the source of the
laboratory space only.
funds to be listed on the certificate of approval.
Type(s) of Funding
2.2.B. For Industry Sponsored studies, please provide a sponsor contact.
2.2.C. Please enter any applicable information about your funding which is
not already shown in Box 2.3 or 2.4 (including funding applied for but not
yet received).
Source of Funds
Question 2.3 lists the research funding
applications/awards that have been submitted to
Please clearly identify the application for research funding associated with the UBC Office of Research Services and entered
this ethics application. This will ensure that awarded research funds can be into our database. Identifying the associated
research funding application/award will ensure
made available to you once this ethics application receives approval.
that awarded research funds will be made
available to you once this ethics application
receives approval.
2.3. Research Funding Application/Award Associated with the
Study that was Submitted to the UBC Office of Research Services
Please click "Add" to identify the research funding application/award
associated with this study. Selecting "Add" will list the sources of all
research funding applications that have been submitted by the PI (and the
person completing this application if different from the PI). If the research
funding application/award associated with this study is not listed below,
please enter those details in question 2.4.
UBC Number
Title
Funding PI
Sponsor
Please ensure you select the correct application.
Note that the first two digits of the application
number indicate the year the application was
submitted (e.g., Application #F08-00001 was
submitted in 2008).
2.4. Research Funding Application/Award Associated with the
Study not listed in question 2.3.
Please click "Add" to enter the details for the research funding
application/award associated with this study that is not listed in question
2.3. When you press "Add" you can do a search for your funding award by
doing a search in the "Sponsor" box - over 7000 options are listed
Title
Sponsor
U.S. Funding
* 2.5.A. Is this a DHHS grant? (To view a list of DHHS funding agencies
click on "add" in 2.5.B below)
Yes
No
2.5.B. If yes, please select the appropriate DHHS funding agency from the
selection box, and attach the grant to box 9.8. of the application.
DHHS Sponsor List
The Department of Health and Human
Services, DHHS (US Federal Agencies), requires
the Research Ethics Board to review the actual
grant application to compare it to the protocol
being approved, to ensure that they are the
same. Your certificate of approval will not be
released until this documentation is attached.
Attach DHHS Grant Application for each sponsor listed above
Title
* 2.6. Conflict of Interest
The REB needs to be satisfied that participants
are informed of conflict of interest matters in the
consent process. Note that "immediate family
Do any of the following statements apply to the Principal Investigator, Co- members" includes partners and children
Investigators and/or their partners/immediate family members?
(whether living in the household or not). The
REB does not require that the investigator
identify holdings in managed mutual funds to be
 Receive personal benefits in connection with this study over and
above the direct cost of conducting this study. For example, being declared in the conflict of interest statements. If
paid by the funder for consulting. (Reminder: receiving a "finders you answer yes to this question you will be
asked to provide more detail on view 3 of the
fee" for each participant enrolled is not allowed).
application.
 Have a non-financial relationship with the sponsor (such as unpaid
consultant, advisor, board member or other non-financial interest).
 Have direct financial involvement with the sponsor (source of
funds) via ownership of stock, stock options, or membership on a
Board.
 Hold patent rights or intellectual property rights linked in any way
to this study or its sponsor (source of funds).
Yes
No
4. STUDY TYPE - HUMAN ETHICS APPLICATION
* 4.1. UBC Research Ethics Board
UBC's REBs have signed a one board of
record agreement. Studies taking place at
Indicate which UBC Research Ethics Board you are applying to and the type multiple UBC sites require review and
of study you are applying for:
approval by only one UBC-Affiliated REB.
Choice of Board should be determined by
BC Cancer Agency Research Ethics Board - Behavioural
the PI's primary appointment and/or the
main location of the research.
Clinical projects are those involving surgery,
the administration of drugs, medical imaging or
other diagnostic techniques, biopsies, the taking
of blood or other specimens, the review of
clinical medical records, and any invasive
procedure. A clinical research project that also
includes questionnaires or interviews should be
submitted to a Clinical Research Ethics Board.
Behavioural projects are those that are
behavioural or social scientific in nature or
involve humanities research. They may involve
the study of patients or healthcare providers;
however, they are not clinical and do not involve
invasive procedures. They do include research
involving interviews, observations, and the
administration of questionnaires or tests.
* 4.2. Institutions and Sites for Study
4.2 Where the research will be "carried out
under this Research Ethics Board approval"
Enter the locations for the institutions and sites where the research will be means at sites which have a UBC REB that is
carried out under this Research Ethics Board approval (including specimens included in the "one board of record
processed by pathology, special radiological procedures, specimens
agreement", which are;
obtained in the operating room, or tissue requested from pathology).

BC Cancer Agency sites

Children's & Women's Health Centre of
If your research will not be carried out at an institutional site, please check
BC sites
the “N/A” box. Otherwise click "Add" and enter the appropriate letter to see

Providence Health Care sites
the locations for the institutions and sites where the research will be

UBC Campus sites
carried out under this Research Ethics Board approval: B for BC Cancer

Vancouver Coastal Health (VCHRI/VCHA)
Agency C for Children's and Women's Health Centre of BC P for Providence
sites.
Health Care U for UBC Campus V for Vancouver Coastal Health
(VCHRI/VCHA).
4.2.B Other locations that are outside of a
Hospital/Institution but still under the
N/A:
jurisdiction of a UBC REB as noted above.
4.2.A. Institutions and Sites for Study
Hospital/Institution
Site
4.2.B.
Please enter any other locations where the research will be conducted
under this Research Ethics Approval (e.g., private physician's office,
community centre, school, classroom, participant's home, in the field provide details).
Institutional Approval: Research at UBC's
affiliated hospitals cannot commence until you
receive local site / resource approval from the
hospital(s) selected. Issuing of the certificate of
ethical approval may be delayed until site
approval from the hospital(s) has been obtained.
The Hospital Administrator for facilities/services
at the hospital or centre selected will be granted
viewing access to this application; however, it is
the PI's responsibility to pursue and obtain the
necessary approvals from the various hospitals.
4*. BEHAVIOURAL STUDY REVIEW TYPE - HUMAN ETHICS APPLICATION
Relationship to Previous Ethics Applications
4.3.A.
Indicate whether the study is an extension or a
sub-study of a primary study or if the study is
utilizing data collected under a previous study.
If this proposal is closely linked to any other proposal
previously/simultaneously submitted, enter the Research Ethics Board
number of that proposal.
A sub-study is a concurrent study on a subsample/population of the original study
sample/population.
If a study has been rejected by another UBCaffiliated REB, it may not be re-submitted to any
other UBC-affiliated REB.
4.3.B.
If applicable, please describe the relationship between this proposal and
the previously/simultaneously submitted proposal listed above.
4.3.C.
Have you received any information or are you aware of any rejection of this
study by any Research Ethics Board? If yes, please provide known details
and attach any available relevant documentation in question 9.7.
Yes
No
Peer Review
If this research proposal has received any independent
scientific/methodological peer review, please include the names of
committees or individuals involved in the review. State whether the peer
review process is ongoing or completed.
* 4.4.A.
External peer review details:
According to Article 2.7 of the TCPS2, "Research
in the humanities and social sciences that poses,
at most, minimal risk shall not normally be
required by the REB to be peer reviewed".
For research posing more than minimal risk, the
REB recognizes that an independent peer review
may be either 'internal' or 'external'. The
appropriate type of review is dependent on the
nature of the study.
For graduate student projects submitted to the
BREB, the approval of the supervisory committee
is deemed to constitute sufficient peer review.
* 4.4.B.
Internal (UBC or hospital) peer review details:
* 4.4.C.
If this research proposal has NOT received any independent
scientific/methodological peer review, explain why no review has taken
place.
If you have any peer review reports attach them
to section 9.7 of the RISe application.
Minimal Risk
* 4.5.A
After considering the level of risk your research involves and the
vulnerability of your study population, please tick one box below that best
represents the overall level of risk your study entails.
Research Risk
Participant
Vulnerability
Low
Low
Medium
High
1
1
2
Medium
1
2
3
High
2
3
3
The TCPS2 defines minimal risk as: “research in
which the probability and magnitude of possible
harms implied by participation in the research is
no greater than those encountered by
participants in those aspects of their everyday
life that relate to the research”.
In considering whether your study is minimal
risk you should consider participant
vulnerability and the research risk
itself. Vulnerability is “A diminished ability to
fully safeguard one’s own interests in the context
of a specific research project” (TCPS2, p. 197).
Please check one box Considerations of research risk should factor in
the type of potential harm that might result (e.g.
only
psychological or informational), the magnitude
or seriousness of the harm (e.g. transient or
permanent), and the probability of occurrence of
the harm (e.g. likely or remote).
* 4.5.B
Explain/justify the level of risk and group vulnerability reported above.
If your study involves low
vulnerability participants and low/medium
research risk, or low research risk and
low/medium vulnerability participants, it is
assigned an overall risk level of 1 and falls under
the "minimal risk" category.
Click here for further information on the risk
matrix and minimal risk criteria.
* 4.5.C
Does your application fall under "minimal risk" (i.e., it was assigned an
overall risk level of 1 on the minimal risk matrix) and therefore is eligible to
be considered for Delegated Review?
* 4.6. Harmonized Review of Multi-Jurisdictional Studies
Is this study a multi-jurisdictional study that requires review by one or
more institutions? (Note: If submitting an amendment for an already
approved study, you must respond "No" to this question)
Yes
No
A multi-jurisdictional study is a research study
that requires review and approval by more than
one Canadian research ethics board (i.e., by
more than one Canadian REB as well as a UBC
affiliated REB) as a result of the requirements of
the TCPS2 and/or UBC's and/or another
institution's human ethics policies.
When you click "Yes" to question 4.6 you will be
directed to a branch off which asks specific
questions about multi-jurisdictional studies.
4.7.A Creation of a Research Database or Registry
Does this study involve the creation of a research database or registry for
future unspecified research? [if no, skip to 4.8]
Yes
No
If submitting an amendment for an already
approved study, you must respond "No" to this
question.
Research databases or registries are repositories
that collect and store information about humans
specifically for future unspecified research
purposes. The information may or may not
include personally identifying information, test
results, information about ethnicity, age, or
place of origin, etc., that is collected
retrospectively or prospectively.
Wanting to use routinely collected teaching or
4.7.B
program evaluation data for future unspecified
research purposes would fall into this category.
Is the purpose of this application exclusively to obtain approval for the
creation of a research database or registry? [Note: if the creation of the
database or registry is part of a bigger project also included in this
application, you must answer "no" below].
Yes
No
When you click "Yes" to question 4.7.A you will
be directed to a branch off which asks specific
questions about the registry or database you are
creating. If your application is exclusively to
obtain approval for the creation of the database
or registry, the application will truncate and you
will be directed to view 9. If the creation of the
database is only one component of the
application, you will need to fill out views 5-8.
C. Creation of a Research Database, Registry or Biorepository - HUMAN ETHICS APPLICATION
* C.1. What is the scope and purpose of the database, registry or
biorepository?
Some institutions may request that a Privacy
Impact Assessment (PIA) be completed when
creating a research database or
registry. Consult your hospital or institutional
privacy office for more information.
In addition to other attributes, biorepositories
may be considered as: a) mono-user biobanks
(i.e., a collection aimed at supporting a specific,
single research project; b) an oligo-user biobank
(i.e., a collection aimed at supporting several
research projects, a research group or a
research consortium); or c) a poly-user biobank
(i.e., a collection aimed at supporting
undetermined, multiple users with REB-approved
research projects, through a defined
access/application mechanism).
* C.2. What are the anticipated public and scientific benefits of the
database, registry or biorepository?
C.3. Over what period of time will data be collected?
C.4.A. Sources
Include a clear date range of the information
that will be included in the registry or
biorepository. If data will be collected
indefinitely, clearly indicate that data will be
collected indefinitely or until the participant
withdraws, if applicable.
Answer C.4.A. and B if your project involves
creation of a database or registry.
What information source(s) are you accessing?
Answer C.4.C. if your project involves
creation of a biorepository.
C.4.B.
Provide specific details about the source(s), i.e., including name of the
database or type of health records, location etc.
C.4.C.
What are the sources of your biospecimens, check all that apply.
Direct from live subject (procedure conducted for research
purposes)
Select biospecimen source:
If "Other" or multiple sources will be used, specify them here:
Indirect from live subject (procedure conducted for clinical
purposes and excess tissue leftover after clinical diagnosis obtained
for research)
Select biospecimen source:
If "Other" or multiple sources will be used, specify them here:
Post mortem tissue collection
Select biospecimen source:
If "Other" or multiple sources will be used, specify them here:
Tissue biospecimens are any human
biospecimens or biological material comprised of
whole solid tissues, cells isolated from solid
tissues and fluids other than blood.
* C.5.A. Confidentiality
Are you collecting personally identifying information/will the biospecimens
be linked to personally identifiable information? [If not, skip to C.9]
Yes
No
C.5.A. Personally identifying information is
any information that may reasonably be
expected to identify an individual, alone or in
combination with other available information,
e.g. name, SIN, PHN, date of birth, address, or
unique personal characteristic etc.
C.5.B.
C.5.B. Important Note: For databases or
registries, a data collection form should be
Indicate the type of personally identifying information you will be collecting
attached to question 9.8. of the application
that will be linked to the specimens. Include a justification for its inclusion
in the registry or database and/or retention of the link.
C.5.C. Irreversibly Anonymized data are
irrevocably stripped of direct identifiers, a code
is not kept to allow future re-linkage, and risk of
C.5.C.
re-identification of individuals from remaining
How long will data remain identifiable/ specimens be linked (i.e., when, if indirect identifiers is low to very low.
ever, will it be irreversibly anonymized). Justify why data/specimens need
to remain identifiable, if this is the case.
C.5.D.
C.5.D. Include the name, degree, affiliation, role
on the project, and email address of ALL
individuals who have access to personally
identifying information.
List the individuals (who are not already listed on page 1 of the application)
who will have access to personally identifying information at any stage in
the data collection or review/abstraction of the data/analysis of the
specimens including those who will have access to master lists of keys
linking identifiable participants to research data/specimens.
Name
Degree
Affiliation
Role on project
Email
* C.6.A. Consent
Will participants consent to be included in the database or registry? Have
their specimens been included in the biorepository? [If no, skip to C.7.]
Yes
No
C.6.B.
Important Note: Attach a copy of the
consent form to Box 9.2. of the application.
Pre-procedure consent is consent obtained prior
to the individual undergoing a medical procedure
(e.g., surgery or biopsy to remove a tumour).
Post-procedure consent is consent obtained after
the individual has undergone a medical
procedure. For additional information click here.
Specify who will explain the consent form and invite participants to
contribute. Include details of where consent will be obtained and under
what circumstances. For biorepositories, please explain whether the
consent process is pre-procedure or post-procedure.
* C.7.
If you are collecting personally identifying information or if you are
collecting biospecimens that will be linked to personally identifiable
data and do not plan to obtain individual participant informed
consent, please provide justification for not doing so following the criteria
outlined on the right. Please address each criterion individually.
Refer to TCPS2 5.5 D. Consent and Secondary
Use of Identifiable Information for
Research Purposes:
Article 5.5 Researchers who have not obtained
consent from participants for secondary use of
identifiable information shall only use such
information for these purposes if the REB is
satisfied that:
a.
b.
identifiable information is essential to
the research;
the use of identifiable information
without the participants' consent is
unlikely to adversely affect the welfare
of individuals to whom the information
relates;
c.
d.
e.
f.
the researchers will take appropriate
measures to protect the privacy of
individuals, and to safeguard the
identifiable information;
the researchers will comply with any
known preferences previously expressed
by individuals about any use of their
information;
it is impossible or impracticable to seek
consent from individuals to whom the
information relates; and
the researchers have obtained any other
necessary permission for secondary use
of information for research purposes.
If a researcher satisfies all the conditions in
Article 5.5(a) to (f), the REB may approve the
research without requiring consent from the
individuals to whom the information relates.
* C.8.A. Participant access to data and withdrawal
Will individual participants have the right to access their data, or right to
amend or withdraw their information?
Yes
No
C.8.B. Provide details of the process for accessing and/or withdrawing
data, including what data can be withdrawn.
* C.9. What is the entity or who is the person that will have custodianship A data/biorepository custodian is an entity
of the database or registry/bio-repository?
or person who is responsible for overseeing the
management and use of the data/biorepository,
including the main rules governing use of the
database/ biorepository, the process by which
access requests will be reviewed, and the
organization to whom the researcher is
accountable for the proper management of the
data/biospecimens.
* C.10. What will be the address of the database, registry or the location
of the biorepository?
This should be a mailing address; however, if
there is a URL, please also provide it.
* C.11. What steps will be taken to ensure the security of the
data/biospecimens?
Reference procedural measures, technical
measures, and physical measures planned for
the protection of data. If a coding procedure is
being used, describe the procedure in detail in
this box.
* C.12. For databases and registries, describe the risks associated with the
possible disclosure of the data. Include any foreseeable circumstances
where disclosure of identifying data may be required by law.
* C.13.A. Data/Biospecimen Transfer
Will data/biospecimens be sent outside of the institution? [If no, skip to
C.14]
Yes
No
Note that if this changes in the future an
amendment must be submitted before data is
transferred.
C.13.C. Attach a copy of the data transfer
agreement to box 9.8. of the application.
C.13.B.
Explain why it is necessary to send the data/biospecimens outside of the
institution, and indicate what data/biospecimens will be sent, where it/they
will be sent, who it/they will be sent to, how it/they will be transferred
(faxed, emailed, couriered, encrypted electronic transfer etc.) and where
it/they will be stored.
C.13.C.
Will there be a data transfer/material transfer agreement?
Yes
No
* C.14.A. Data Linking
Do you plan to link all or some of the data or the biospecimens to another
data source (e.g., database, biorepository)?
Yes
Note that if this changes in the future an
amendment must be submitted before data is
linked.
No
C.14.B.
Identify the data set, how the linkage will occur, and provide a list of data
items in the other database. Also, identify what personal information will be
used to link the databases and how confidentiality regarding this shared
information will be preserved.
* C.15.A. Data Retention
How long are you planning to keep the data/biospecimens?
C.15.B.
If the data/biospecimens will be destroyed, indicate the planned method
for erasure/destruction of the data/biospecimens.
* C.16.A. Future Use
Will the information in the database/biorepository be retained as an
ongoing database/biorepository (or as part of an ongoing
database/biorepository) for future research? [If no, skip to C.17]
Yes
No
C.16.B. Reference who will have access to the
database in the future and under what
circumstances, what will happen if an individual
data custodian leaves the institution, where the
ongoing database will be stored or maintained,
and what security measures will be in place.
UBC's REBs encourage researchers who are
creating biorepositories to consider certification
C.16.B.
of their biorepository with the Canadian Tumour
Repository Network (CTRNet) Biobank
Provide a full description of the data/biospecimen stewardship process,
Certification Program or accreditation with the
including whether the dababase/biorepository will have formalized standard
College of American Pathologists (CAP)
operating procedures.
Biorepository Accreditation Program.
* C.17.
Describe any commercial uses for which the data/biospecimens may be
used, including any disclaimers concerning participant remuneration for
such use.
C.18. Registration for Publication of Clinical Trials
If there is any possibility of the intent to publish
results of the study it must be registered
BEFORE the study is started, (but not
C.18.A.
necessarily before ethical approval is
granted.)The International Committee of Medical
Does this clinical study fall within the definition stated on the right (in the
Journal Editors (ICMJE) now require registration
guidelines)?
for all clinical trials as defined by "Any research
project that prospectively assigns
human participants or groups of humans to one
Yes
No
or more health-related interventions to evaluate
the effects on health outcomes". Health related
C.18.B.
interventions include any intervention used to
modify a biomedical or health-related outcome;
for example, drugs, surgical procedures,
If "Yes", click "Add" to enter the following information. (Please note that
registration by UBC ORS administration requires the prior ethical approval devices, behavioural treatments, dietary
of the study. In that case, registration information should be added when it interventions, and process-of-care
changes). Health outcomes include any
becomes available.)
biomedical or health related measures obtained
in patients or participants, including
Has it been
Authorized Registry
Clinical Trial unique
pharmocokinetic measures and adverse events.
registered?
used
identifier
Purely observational studies (those in which the
assignment of the medical intervention is not at
the discretion of the investigator) do not require
registration. For more information concerning
registration requirements, click here.
E. Harmonized Review of Multi-Jurisdictional Studies - HUMAN ETHICS APPLICATION
* E.1. Is this the first/initial application for review of the multi-jurisdictional The first/initial application for review is the first
study at any of the sites where the research is going to be conducted?
application for ethical review of the research
submitted to any of the Institutions with which
UBC has a signed reciprocity agreement.
Yes
No
* E.2. Are you the Lead Investigator for this multi-jurisdictional study?
(See definition on right)
Yes
No
UBC has entered into partial reciprocity and
collaborative review arrangements with certain
other institutions and entities in situations where
a study requires review and approval by more
than one Canadian Research Ethics Board. For
detailed guidance on harmonization processes
and requirements click here. For a list of
institutions with which UBC has a reciprocity or
collaborative review agreement click here.
The Lead Investigator is the only Investigator
conducting the multi-jurisdictional study at
various sites or the Investigator chosen from
amongst numerous Investigators from various
sites to lead the multi-jurisdictional study.
The Lead Investigator is the Investigator who
submits the first/initial application for ethical
review of the multi-jurisdictional study at any of
the sites where the research is going to be
conducted. The Lead Investigator is required to
submit the initial application for review of the
research to his or her home institution's REB
regardless of where the research is taking place.
If this is an initial application for review of the
study and you are NOT the lead investigator,
you cannot continue with this submission.
If you are a UBC faculty member, you cannot
answer 'no' to question E.1 and 'yes' to question
E.2 because UBC must perform the review of
initial/first application since UBC is your home
institution.
E.3. Please indicate which institution with which UBC has an Ethics Review If your institution appears on this list the
Agreement is your home institution.
application will truncate to view 9, where you
will need to append all UBC site specific
Check the institution below
documents as applicable. Please append to view
9 all available documentation and information
from the Lead PI and his/her REB, including the
Lead PI’s REB Application, Certificate of
Approval, Informed Consent and recruitment
documents and all available correspondence
between the Lead PI’s REB and the Lead PI,
including, if available, the minutes from the Lead
PI REB’s review of the study.
If your institution does not appear on this list,
you will be directed to 4.8 and will need to fill
out the full REB application.
5. SUMMARY OF STUDY AND RECRUITMENT - HUMAN ETHICS APPLICATION
Study Summary
5.1.A
The summary should include the following: the
research question and/or hypothesis (where and
if a hypothesis is appropriate to the study), the
study population, and the study methods.
Provide a short summary of the project written in lay language suitable for
non-scientific REB members. DO NOT exceed 100 words and do not cut
The REB will review the study proposal attached
and paste directly from the study proposal.
to question 9.1 for the expanded description of
how the study aims will be achieved and how the
analysis will be undertaken. The board's main
interest here is what the researcher will actually
be doing with participants as he/she undertakes
* 5.1.B
the study so that they can assess potential risks
to the participants and how the researcher is
Summarize the research proposal:
handling them, etc.
5.2. Inclusion Criteria
Describe the participants being selected for this study, and list the criteria
for their inclusion.
5.3. Exclusion Criteria
Describe the purpose in lay language or include
definitions of jargon or technical terms. Also, all
acronyms must be written out in full the first
time that they appear in the application form,
recruiting and consent materials.
Please enter the inclusion criteria as an itemized
list.
The selection of participants must take TCPS2
article 4.1 into consideration, which states that
“Taking into account the scope and objectives of
their research, researchers should be inclusive in
selecting research participants”. However, the
TCPS2 cautions against recruiting participants
into research studies solely because they are
easy to access or manipulate.
If applicable, provide all exclusion criteria. If not
applicable, write "N/A".
Describe which participants will be excluded from participation, if any, and
list the criteria for their exclusion.
Article 4.1 of the TCPS2 states that "researchers
shall not exclude individuals from the
opportunity to participate in research on the
basis of attributes such as culture, language,
religion, race, disability, sexual orientation,
ethnicity, linguistic proficiency, gender or age,
unless there is a valid reason for the exclusion".
Provide justification for excluding participants on
the basis of such attributes.
5.4. Recruitment
Provide a detailed description of the method of recruitment. For example,
describe who will contact prospective participants and by what means this
will be done. Ensure that any letters of initial contact or other recruitment
materials are attached to this submission on view 9 (section 9.7).
Please enter the exclusion criteria as an itemized
list.
Privacy legislation in BC states that organizations
cannot provide contact information for clients
without their consent unless the researchers
have obtained permission from the Provincial
Privacy Commissioner.
Click here for information on recruitment.
UBC policy does not allow initial contact by
telephone. However, surveys which use random
digit dialing may be allowed. If your study
involves initial contact by random digit dialing,
please click here to complete the Telephone
Contact Form, then save and attach the form to
question 9.6.
5.5. Use of Records
If existing records (e.g., health records, course grade sheets or other
records/databases) will be used to IDENTIFY potential participants, please
describe how permission to access this information, and to collect and use
this information, will be obtained.
* 5.6. Summary of Procedures
5.7. Checklist for Research Methods
Are any of the following procedures or methods involved in this study?
Check all that apply.
Where the investigator is in a dual relationship that is, the researcher maintains the records
(e.g., as a clinician, educator, etc.) and is
proposing to undertake research on them, steps
need to be taken to ensure participants' rights
are not violated.
Describe in a step-by-step manner the research
procedures. If the study involves an
experimental approach to curriculum or therapy,
specify how the procedures differ from normal
practice. If Deception is involved, please click
here to complete the Deception Form, then save
and attach the form to question 9.7.
This does NOT represent a comprehensive
list of research methods. These methods are
included here because they represent possible
departures from established processes for
obtaining free and informed consent. Therefore,
please do not tick the "expert interviews" box
unless you are actually doing expert interviews.
Please ensure you have included a detailed
description of any of the procedures or methods
selected here in the procedures question 5.6.
Click here for further information on these
methods of data collection.
6. PARTICIPANT INFORMATION AND CONSENT PROCESS - HUMAN ETHICS APPLICATION
* 6.1. Time to Participate
How much time will a participant be asked to dedicate to the project?
6.2. Risks
Describe what is known about the risks of the proposed research for
participants.
6.3. Benefits
Describe any potential benefits to the participant that could arise from his
or her participation in the proposed research.
6.4. Impacts on Community
If your research involves an identified group or 'community', outline the
likely impacts of the research on the community.
Include how many minutes/hours over how
many weeks/months the participant will be
asked to dedicate to the project. If your study
involves no direct interaction with participants
(e.g., naturalistic observation) you would
respond “N/A”.
Ensure that you also include this information in
the consent process and that the amount of time
stated is consistent in the application,
recruitment letters or posters, and consent
information.
Include information about any physical, social, or
psychological risks that the participants are likely
to experience as a result of taking part in the
study.
Click here for further information on risks.
Specify the benefits to the participants. If there
are no benefits, state this explicitly. If any
specific therapeutic benefits cannot be assured,
but may be hoped for by the participant, state
explicitly that the participant may or may not
benefit from participation in the study.
Research involving identified groups often has
impacts (both positive and negative) that go
beyond individual participants.
The REB cautions against analyses that may
contribute to stereotyping of groups on the basis
of ethnic or cultural background, sexual
orientation, etc. Therefore, when the study
includes specific groups or a range of groups and
asks participants to categorize themselves
according to ethnicity, colour, etc., the
researcher must describe the nature of the
analysis to be undertaken.
6.5. Reimbursement
Describe any reimbursement for expenses (e.g., meals, parking,
medications) or payments/gifts-in-kind (e.g., honoraria, gifts, prizes,
credits) to be offered to the participants. Provide full details of the
amounts, payment schedules, and value of gifts-in-kind.
6.6. Obtaining Consent
Specify how potential participants will be invited to take part in the
study. Include details of where the consent will be obtained and
documented, and under what circumstances.
If Aboriginal groups are the focus of analysis
then the REB takes direction from chapter 9 of
TCPS2.
In accordance with TCPS2, the REB takes a
neutral stance on the use of
incentives. However, "where incentives are
offered to participants, they should not be so
large or attractive as to encourage reckless
disregard of risks... The offer of incentives in
some contexts may be perceived by prospective
participants as a way for them to gain favour or
improve their situation. This may amount to
undue inducement" (see TCPS2 Article 3.1).
Click here for further information on
reimbursement and payments.
Article 3.12 of TCPS2 states that “Evidence of
consent shall be contained either in a signed
consent form or in documentation by the
researcher of another appropriate means of
consent” (see also Article 10.2).
Include the following details:
1. Who would approach the participant to obtain
consent.
2. Who would inform and take the consent from
the participant.
3. What is the relationship of the person
obtaining consent to the participant.
The REB recognizes that written consent is not
necessarily appropriate for certain types of
research. Researchers wishing to obtain oral
consent should describe the alternative means of
obtaining and documenting consent. A script of
the oral consent process should be appended
to question 9.2 of the application.
6.6.A. Waiver of Consent
Conditions for waiver/alteration of consent:
1) The research involves no more than minimal
If you are asking for a waiver or an alteration of the requirement for
risk to participants;
participant informed consent please justify the waiver or alteration and
2) The lack of consent is unlikely to adversely
confirm that the study meets the criteria on the right. Please address each affect the welfare of the participant;
criterion individually.
3) It is impossible or impracticable to carry out
the research and to answer the research
question properly without the waiver or
alteration;
4) Whenever possible and appropriate, the
participants will be debriefed and provided with
additional pertinent information after
participation;
5) The waivered or altered consent does not
involve a therapeutic intervention.
6.7. Time to Decide
TCPS2, Article 3.2 states, “For consent to be
informed, prospective participants should have
How long after being provided with detailed information about the study
adequate time and opportunity to assimilate the
will the participant have to decide whether or not to participate? Provide
information provided, pose any questions they
your rationale for the amount of time given.
may have and discuss and consider whether
they will participate. The time required for this
initial phase of the consent process will depend
on such factors as the magnitude and probability
of harms, the complexity of the information
conveyed and the setting where the information
is given”.
* 6.8. Capacity to Consent
Click here for information on individuals who lack
the capacity either temporarily or permanently
to consent for themselves.
Will every participant have the capacity to give fully informed consent on
his/her own behalf? Please click "Select" to complete the question and
view further details.
Please note that not having attained the legal
age of majority in BC (19 years) does not
necessarily mean that the participants are
unable to provide their own consent.
6.9. Renewal of Consent
TCPS2, Article 3.3 states, "In general,
participation should be based on consent that is
Describe any situation in which the renewal of consent for this research
voluntary, informed, and ongoing throughout the
duration of the research”.
might be appropriate, and how this would take place.
6.10. Provisions for Consent
What provisions are planned for participants, or those consenting on a
participant's behalf, to have special assistance, if needed, during the
consent process (e.g., consent forms in Braille, or in languages other than
English).
Renewal of consent might be particularly
appropriate in the context of longitudinal,
ethnographic or other research methods
involving multiple contacts with participants.
Attach copies of contact letters or
consent documents that have been translated
into other languages to question 9.2 of the
application.
6.11. Restrictions on Disclosure
Describe any restrictions regarding the disclosure of information to
research participants (during or at the end of the study) that the
funder/sponsor has placed on investigators, including those related to the
publication of results.
Click here for information on UBC's Conflict of
Interest policy.
7. NUMBER OF PARTICIPANTS AND LOCATIONS FOR BEHAVIOURAL STUDY - HUMAN ETHICS
APPLICATION
* 7.1. External Approvals
7.1 A. External Approvals
External approvals for research involving other institutions and other
jurisdictions: Provide written proof of agency approval for projects carried
out at other institutions and, when applicable, other jurisdictions.
Written evidence of approval (to use the
premises or to access students, clients, patrons
or patients) is required for projects carried out
at other institutions. If agency approval cannot
be obtained without prior approval of the UBC
REB, a letter of conditional approval will be
issued for submission to the institution if all
other aspects of the application are satisfactory.
Please indicate whether a request for approval
has been submitted to the institution or whether
conditional approval by the UBC REB must
accompany a request to the institution for
approval.
Indicate external approvals below:
A.
Other Institutions:
Yes
No
B.
Please select "Add" to enter the name of the institution and if you have
already received approval attach the approval letter.
Name of Institution
Document(s)
* C.Other Jurisdiction or Country (if answer is "No" go to 7.1.G):
Yes
No
D.
Please select "Add" to enter the name of the jurisdiction or country and if
you have already received approval attach the approval letter.
Name of Jurisdiction or Country
Document(s)
7.1 E Other Jurisdictions
TCPS2 Article 8.3(b) states, “Research
conducted under the auspices of a Canadian
research institution and conducted outside its
jurisdiction… shall undergo prior ethics review by
both: (i) the REB at the Canadian institution…;
and (ii) the REB or other responsible review
body or bodies, if any, at the host research site.
Please indicate if any agencies have jurisdiction
over the site of the research and whether
approval has been applied for or received. If
formal research ethics approval processes are
not in place at the study site, explain this in 7.1
F.
E.
7.1 G Research with aboriginal communities
Has a Request for Ethics Approval been submitted to the institution or
Click here for TCPS2 Chapter 9 on Research
responsible authority in the other jurisdiction or country? (Send a copy to Involving the First Nations, Inuit and Metis
the Research Ethics Office when approval is obtained).
Peoples of Canada
Yes
No
Click here for CIHR Guidelines for Health
Research Involving Aboriginal People
F.
7.1 H Registration of Clinical Trials
If a Request for Approval has not been submitted, provide the reasons
below:
If there is any possibility of the intent to publish
the results of the study in an ICMJE
(International Committee of Medical Journal
Editors) member journal, and it falls under their
definition of a clinical trial (which includes
behavioural treatments, dietary
interventions and process-of-care
changes), the study must be registered BEFORE
it is started (but not necessarily before ethical
approval is granted). Please click here for
further details and/or check out the Clinical
Research Ethics Board's RISe Application
Guidance Notes.
G. Does this research focus on aboriginal peoples, communities or
organizations?
Yes
No
If "Yes", ensure that you are familiar with the guidance documents linked
on the right. Also attach a copy of the research agreement with the
community (if available) in question 9.7. Please describe the community
consent process. If no community consent is being sought, please justify.
H. Registration for Publication of Clinical Trials. Does this study fall within
the clinical/intervention trial definition stated on the right (in the
guidelines)?
Yes
No
If 'Yes', click 'Add' to enter the following information. (Please note that
registration by UBC ORS administration requires the prior ethical approval
of the study. In that case, registration information should be added when it
becomes available).
Has it been
Authorized Registry
Clinical Trial unique
registered?
used
identifier
7.2. Number of Participants
A.
How many participants will take part in the entire study (i.e., the entire
study, world-wide)?
B.
How many participants will take part at institutions covered by this
Research Ethics Approval (i.e., only at the institutions covered by this
approval)?
* 7.3. Researcher Qualifications
Who will actually conduct the study and what are their qualifications to
conduct this kind of research? (e.g., describe relevant training, experience,
degrees, and/or courses).
Unless you are conducting a multi-sited study
involving several institutions, the responses to A
and B are likely to be the same.
8. SECURITY OF DATA AND CONFIDENTIALITY OF PERSONAL INFORMATION FOR
BEHAVIOURAL STUDY - HUMAN ETHICS APPLICATION
8.1. Security of Data During the Course of the Study
Click here for further information on
Confidentiality.
How will data be stored? (E.g., computerized files, hard copy, videotape,
audio recordings, personal electronic communications device, other.)
How will security of the data be maintained? (For example, study
documents must be kept in a secure locked location and computer files
should be password protected and encrypted, data should not be stored or
downloaded onto an unsecured computer, back up files should be stored
appropriately.)
If any data or images are to be kept on the Web, what precautions have
been taken to prevent them being copied?
8.2. Access to Data
Who will have access to the data (e.g., co-investigators, students or
translators)? How will all of those who have access to the data be made
aware of their responsibilities concerning privacy and confidentiality
issues?
8.3. Protection of Personal Information
Describe how the identity of research participants will be protected both
during and after the research study, including how participants will be
identified on data collection forms.
8.4. Transfer of Data
Will any data that identify individuals be transferred (available) to persons
or agencies outside of the University?
Yes
No
If YES, describe in detail what identifiable information is released, to
whom, how the data will be transferred, how and where it will be stored
and what safeguards will be used to protect the identity of participants and
the privacy of their data. Attach the data transfer agreement if applicable.
Give the names (if known) of those who will
have access to the raw data, which may include
information that would identify the
participants. The research participants must
also be told in the consent process who will have
access to his/her data and what use will be
made of it, either now or in the future.
Temporary student assistants, translators,
transcriptionists and clerks may be referred to
by their role instead of name.
Click here for further information on protection
of personal information.
Data linkage studies: If your study involves
the linkage of several data sources, explain how
confidentiality regarding the shared information
will be preserved.
8.5. Retention and Destruction of Data
According to UBC Policy #85 on Scholarly
Integrity, data must be retained for at least 5
UBC policy requires that data be kept for at least 5 years within a UBC
years within a UBC facility, but may be retained
facility. If you intend to destroy the data at the end of the storage period for a longer period provided that they are stored
describe how this will be done to ensure confidentiality (e.g., tapes should securely.
be demagnetized, paper copies shredded). UBC has no explicit
requirement for shredding of data at the end of this period and it
In some cases, data are of such value that they
may be kept indefinitely. Please note that the responsibility for the
should not be destroyed (e.g., oral history
security of the data rests with the Principal Investigator.
interviews). In these cases, please describe
8.6. Future Use of Data
Are there any plans for future use of either data or audio/video
recordings? Provide details, including who will have access and for what
purposes, below.
8.7. Feedback to Participants
Are there any plans for feedback on the findings or results of the research
to the participant? Provide details below.
your plans to preserve this material. The
consent process should outline these plans and
describe how and when it may be appropriate for
others to have access to this information.
Describe any known future use of the data
beyond the conclusion of this research project,
and indicate whether participant consent will be
obtained in the current consent procedure or the
participant will be contacted later to obtain
consent. Either possibility must be described in
the consent process. If consent is to be obtained
now, the future use of the data must be
described in full to the participant and included
with the current application. If consent for
future use of the data is to be obtained later, full
details must be submitted to the BREB for
review and approval before the research begins.
The BREB acknowledges that in the case of
ethnographic field notes and interviews,
researchers cannot be expected to know all the
uses they plan to make of the data. Therefore,
researchers should inform the peoples they are
studying of the potential for future use of the
data during the consent process.
TCPS2, Chapter 4 on equitable distribution of
research benefits states that researchers should
generally ensure that participating individuals,
groups and communities are informed of how to
access the results of the research. Results of the
research should be made available to them in a
culturally appropriate and meaningful format,
such as reports in plain language in addition to
technical reports.
9. DOCUMENTATION - HUMAN ETHICS APPLICATION
Please attach the documentation for the study. The Research Ethics Office will NOT check the content of each
attachment and cannot change document names or dates.
INSTRUCTIONS
View the guidelines to the right of each section to see where the document should be attached. Documents will
appear on the certificate of approval with the information that you enter when you attach the document. Please
check that version dates, document names etc. are accurate and match those on the attached documents.
Submit final versions only (i.e. not "drafts") except that blanks can be included for names and addresses in
documents to be sent to specific individuals or organizations. Revisions required by the Board should be
highlighted.
New Applications: Attach the documents to the applicable section (refer to guidelines on right)
Response to Proviso or Deferral or Changes Required by REBA:
If you are submitting a revised version of a document that is already attached; delete only the document that
you are replacing and attach the revised version of the same document (Do NOT delete any of the other
documents). You may add a new document but you must indicate in your response that you have added a new
document for review.
Amendments:
If you are submitting a revised version of a document that is already attached; delete only the document that
you are replacing and attach the revised version of the same document (Do NOT delete any of the other
previously approved documents, those should remain in the application).
If you are submitting a new document that is being added to the study; simply attach it to the applicable
section (leave all other previously approved documents in the application).
9.1. Research Proposal
Examples of types of proposals are listed on the right. Click "Add" to enter
the required information and attach the documents.
Document Name
Version Date Document Password (if applicable)
9.2. Documentation of Consent



Grant application
Dissertation proposal
Research proposal




Participant consent form
Parent/guardian consent form
Examples of types of consent documents are listed on the right. Click "Add"
Other consent forms
to enter the required information and attach the documents.
Description of process for obtaining
consent (e.g. oral consent script)
Document Name
Version Date Document Password (if applicable)
 Click here for more guidelines on
behavioural informed consent forms
9.3. Documentation of Assent

Participant assent form

Other assent forms (e.g. oral assent
Examples of types of assent documents are listed on the right. Click "Add"
script)
to enter the required information and attach the documents.

Click here for more information on
assent for the Vancouver & Okanagan
Document Name
Version Date Document Password (if applicable)
BREBs
 Click here for UBC C&W Research Ethics
Board assent template
9.4. Advertisement to Recruit Participants
Advertisement to Recruit Participants This
includes any type of communication (e.g. flyer,
Examples are listed on the right. Click "Add" to enter the required
radio/television script, poster, newspaper ad,
information and attach the documents.
internet message) that is directed to potential
participants for the purpose of recruitment. The
Document Name
Version Date Document Password (if applicable)
purpose of this documentation is to ensure that
the recruitment measures are appropriate and
not coercive.
Click here for BCCA Research Ethics Board
policies participant handouts and
advertisements.
Click here for UBC C&W Research Ethics
Board policies on participant handouts and
advertisements.
9.5. Questionnaire, Questionnaire Consent Cover Letter, Tests,
Interview Scripts, etc.
Please click "Add" to enter the required information and attach the
documents.
Document Name
Version Date Document Password (if applicable)
9.6. Letter of Initial Contact
Please click "Add" to enter the required information and attach the forms.
Document Name
Version Date Document Password (if applicable)
9.7. Other Documents
A.
Other documents: Examples of other types of documents are listed on the
right. Click "Add" to enter the required information and attach the
documents.
Document Name
Version Date Document Password (if applicable)
If the study is limited to a questionnaire that is
completed by the participant, a consent cover
letter may be used in lieu of a standard consent
form, provided it includes essentially the same
information as a consent form, plus a sentence
that states that "If the questionnaire is
completed, it will be assumed that consent
has been given". If a study involves other
procedures and a consent form, a covering letter
is not required, unless the questionnaire is
completed or sent to the participant at a later
date.
If the questionnaire will be accessed online,
details of the survey webhost should be provided
in 9.7B.
Letters of Initial Contact - This is the
preferred method of recruitment when contact is
initiated by the researcher rather than by the
participant responding to an advertisement and
includes email invitations, follow up emails,
reminders, etc.
Telephone contact form - Initial contact by
telephone is discouraged by the BREB.
Interviews may be conducted by telephone after
making contact by mail/email and obtaining
consent. For surveys where initial contact is
made by random digit dialing, complete and
attach appendix 4 “Telephone Contact Form”.
If applicable, please attach a transcript (the
document must include a version date) of any
CD, tape or audio file and send the hard copy to
the Research Ethics Office.
Other documents regularly required include the
following:

B.
If a Web site is part of this study, enter the URL below. Since URL's may
change over time or become non-existent, you must also attach a copy of
the documentation contained on the web site to one of the sections above
or provide an explanation.

Deception form and written or verbal
debriefing. Please click here to complete
the form, then save and attach it to
question 9.7
Evidence of Agency approvals from other
institutions
If this is an application using the streamlined
process as indicated in Question 4.6, please
append ALL relevant documentation from the
other approving REB, including the application
form, all correspondence from and to the
approving REB, the proposal approved, the
certificate of approval, the other REB approved
informed consents, etc.
10. FEE FOR SERVICE FOR BC CANCER AGENCY - HUMAN ETHICS APPLICATION
The fee for ethical review applies only to research that receives funding
from a "for-profit" sponsor (for example, pharmaceutical/medical devices
company or other for-profit organization).
The fee for ethical review is $3,000. This is a one-time-only fee for each
new application and covers all subsequent transactions (e.g.
amendments, renewals). NOTE: Review of Serious Adverse Events
(SAE's) are not included in this fee and will be billed separately.
The certificate of approval will not be issued until payment of the ethical
review fee (and the BC Cancer Agency Clinical Trial Agreement if
applicable) has been received.
Select here for details of the UBC BC Cancer
Agency Research Ethics Board fee policy.
If the Research Ethics Board (REB) fee is
applicable the BC Cancer Agency REB will send
an invoice to the Principal Investigator and
Primary Contact. It is the responsibility of the
Principal Investigator to ensure payment of this
fee and for communicating this requirement to
the Sponsor.
If payment is being made by cheque please
ensure the following:
Invoice: If payment is not received when your application is submitted
to the Research Ethics Board an invoice will be sent to the applicant.
Cheque Amount: $3,000
It is the responsibility of the Principal Investigator to ensure payment of
this fee and for communicating this requirement to the Sponsor.
Make cheque payable to: "BC Cancer
Agency".
Fee Waiver Criteria
The following types of funding are excluded from the fee requirement:
i.
Cooperative groups (e.g. NSABP);
ii. National Cancer Institute of Canada Clinical Trials Group
iii. Grant from a non-profit organization, for example, CIHR, NIH or a
cancer-specific foundation
iv.
BCCA internal
Payment Reference: Payment must include
either the BC Cancer Agency REB number if
known, otherwise, the project title and Principal
Investigator name must be included.
The fee may be waived in other circumstances if requested (complete the
following to request a waiver).
Mechanism for Submitting the Fee
* A.
Please select one of the following:
B.
Explanation of fee waiver due to circumstances other than those listed
above.
C.
Internal transfer of funds. Funds can only be transferred from another
BCCA account. Please hit "Select" to complete the information.
If you have any questions please contact:Bonnie Shields, Manager BCCA
Research Ethics Board
(604) 877-6284 or reb@bccancer.bc.ca
Mail cheque to: BC Cancer Agency Research
Ethics Board, Fairmont Medical Building, 614 750 West Broadway, Vancouver BC, V5Z 1H5.
11. BC CANCER AGENCY CENTRE PI - HUMAN ETHICS APPLICATION
11.1.
Additional participating centre PIs listed in this
section WILL be listed on the certificate of
Select the Principal Investigator for each participating BC Cancer Agency
approval and WILL have online access to read,
Centre. Once you click "Select", you can enter the PI's name, or enter the edit, and track this application. (Only the PI
first few letters of his or her name and click "Go". You can sort the
named in View 1 can submit an application or
returned list alphabetically by First name, Last name, or Organization by
amendment etc. to the REB).
clicking on the appropriate heading.
Click here for the BC Cancer Agency policy on
A.
listing Principal Investigators and Coinvestigators.
Lead PI for Vancouver Centre:
If a centre PI is on a leave of absence longer
than 6 months they should be replaced with a
new centre PI. If the PI on a leave wishes to
B.
have access while they are away so they can
continue to monitor the study, they should be
Lead PI for Vancouver Island Centre:
added to question 1.3 as a co-investigator.
C.
Lead PI for Fraser Valley Centre:
D.
Lead PI for the Centre for Southern Interior:
E.
Lead PI for the Centre for Abbotsford Centre:
F.
Lead PI for the Centre for the North:
* 11.2.
If this application requries a Clinical Trial Agreement, what is the status of
the Agreement?
The Certificate of Approval will not be released
until the BC Cancer Agency has received a copy
of the signed contract, which should be
attached in question 9.8.
All industry-related and "for-profit" sponsored
studies require a Clinical Trials Agreement
between the sponsor, the BC Cancer Agency
and the investigator.
Click here to review the submission criteria for
a Clinical Trials Agreement.
12. SAVE APPLICATION - HUMAN ETHICS APPLICATION
You have reached the end of the Human Ethics Application.
OPTIONS
1) submit application (PI only) -click the "Continue" button and "Submit application" on the next page. NOTE: the
"Submit application" button is only visible to the PI.
2) work on this application later - click the "Continue" button. Your application will be in "Pre Submission" and saved in
your inbox.